Yu Ying, Yan Long, Lou Yake, Cui Rongrong, Kang Kaijiang, Jiang Lingxian, Mo Dapeng, Gao Feng, Wang Yongjun, Lou Xin, Miao Zhongrong, Ma Ning
1Departments of Interventional Neuroradiology and.
2China National Clinical Research Center for Neurological Diseases.
J Neurosurg. 2021 Oct 29;136(6):1716-1725. doi: 10.3171/2021.6.JNS211201. Print 2022 Jun 1.
This study aimed to identify predictors of intracranial in-stent restenosis (ISR) after stent placement in symptomatic intracranial atherosclerotic stenosis (ICAS).
The authors retrospectively collected data from consecutive patients who suffered from symptomatic ICAS and underwent successful stent placement in Beijing Tiantan hospital. Eligible patients were classified into "ISR," "indeterminate ISR," or "no-ISR" groups by follow-up digital subtraction angiography or CT angiography. A multivariate logistic regression model was used to explore the predictors of intracranial ISR after adjustments for age and sex. In addition, ISR and no-ISR patients were divided into two groups based on the strongest predictor, and the incidence of ISR, recurrent stroke, and symptomatic ISR was compared between the two groups.
A total of 511 eligible patients were included in the study: 80 ISR, 232 indeterminate ISR, and 199 no-ISR patients. Elevated high-sensitivity C-reactive protein (hs-CRP; odds ratio [OR] 4.747, 95% confidence interval [CI] 2.253-10.01, p < 0.001), Mori type B and C (Mori type B vs Mori type A, OR 3.119, 95% CI 1.093-8.896, p = 0.033; Mori type C vs Mori type A, OR 4.780, 95% CI 1.244-18.37, p = 0.023), coronary artery disease (CAD; OR 2.721, 95% CI 1.192-6.212, p = 0.017), neutrophil/lymphocyte ratio (NLR; OR 1.474 95% CI 1.064-2.042, p = 0.020), residual stenosis (OR 1.050, 95% CI 1.022-1.080, p = 0.001) and concurrent intracranial tandem stenosis (OR 2.276, 95% CI 1.039-4.986, p = 0.040) synergistically contributed to the occurrence of intracranial ISR. Elevated hs-CRP (hs-CRP ≥ 3 mg/L) was the strongest predictor for ISR, and the incidence of ISR in the elevated hs-CRP group and normal hs-CRP group (hs-CRP < 3 mg/L) was 57.14% versus 21.52%, respectively, with recurrent stroke 44.64% versus 16.59%, and symptomatic ISR 41.07% versus 8.52%.
Elevated hs-CRP level, NLR, residual stenosis, Mori type B and C, CAD, and concurrent intracranial tandem stenosis are the main predictors of intracranial ISR, and elevated hs-CRP is crucially associated with recurrent stroke in patients with symptomatic ICAS after intracranial stent implantation.
本研究旨在确定症状性颅内动脉粥样硬化性狭窄（ICAS）患者支架置入术后颅内支架内再狭窄（ISR）的预测因素。
作者回顾性收集了北京天坛医院连续收治的症状性ICAS且成功进行支架置入术的患者的数据。通过随访数字减影血管造影或CT血管造影，将符合条件的患者分为“ISR组”、“不确定ISR组”或“无ISR组”。采用多因素逻辑回归模型，在对年龄和性别进行校正后，探索颅内ISR的预测因素。此外，根据最强预测因素将ISR组和无ISR组患者分为两组，比较两组间ISR、复发性卒中及症状性ISR的发生率。
本研究共纳入511例符合条件的患者：80例ISR患者、232例不确定ISR患者和199例无ISR患者。高敏C反应蛋白（hs-CRP）升高（比值比[OR]4.747，95%置信区间[CI]2.253 - 10.01，p < 0.001）、森田B型和C型（森田B型与森田A型相比，OR 3.119，95%CI 1.093 - 8.896，p = 0.033；森田C型与森田A型相比，OR 4.780，95%CI 1.244 - 18.37，p = 0.023）、冠状动脉疾病（CAD；OR 2.721，95%CI 1.192 - 6.212，p = 0.017）、中性粒细胞/淋巴细胞比值（NLR；OR 1.474，95%CI 1.064 - 2.042，p = 0.020）、残余狭窄（OR 1.050，95%CI 1.022 - 1.080，p = 0.001）以及并存颅内串联狭窄（OR 2.276，95%CI 1.039 - 4.986，p = 0.040）共同促使颅内ISR的发生。hs-CRP升高（hs-CRP≥3 mg/L）是ISR的最强预测因素，hs-CRP升高组和hs-CRP正常组（hs-CRP < 3 mg/L）的ISR发生率分别为57.14%和21.52%，复发性卒中发生率分别为44.64%和16.59%，症状性ISR发生率分别为41.07%和8.52%。
hs-CRP水平升高、NLR、残余狭窄、森田B型和C型、CAD以及并存颅内串联狭窄是颅内ISR的主要预测因素，hs-CRP升高与症状性ICAS患者颅内支架置入术后复发性卒中密切相关。
